Research on Electronic Medical/Health Record System suited for Developing Countries Environment

(Indonesia)

Medic-One Private Emergency Medical Service Study Case

http://www.medic-one.org

Yunan SatriaWaseda University - GITS

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15 May 2009Seagaia Meeting 2009, Okinawa

Current Fact & Situation• In developing country like Indonesia, Emergency Medical Services (pre-

hospitalization) is soon expected to have a more sophisticated and efficient way to manage information flow among each expertise.

• Critical locations of Urgent Care Point Facility, Alarm Call Center and Fleet of Paramedics are located in different area within the city.

• Current electronic medical records are created and stored within Urgent Care Point Facility and unfortunately still in Word Document format, and can only be accessed locally for printout.

• Alarm Call Center and Fleets of Paramedics needs to access patient medical/health information.

• Fleet of Paramedics currently use only Emergency TRIAGE for standard guidelines in emergency medical situation without knowing the patient past medical history.

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Current Fact & Situation

Figure 1. Jakarta City Map (modified)Source: Google maps

Figure 2. Medic-One Operational SystemSource: Self Designed

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Problem Description

• Now Patient Health Data is only accessible locally within the Urgent Care Point facility and it is also in the Word Document is not a flexible format for Electronic Health Record, and it cannot be a future standards for Electronic Health Record

• Alarm Call Center Team and Fleet of Emergency Paramedics also need to access Patient Health Data for a better medical judgment to rescue, not only based on TRIAGE standards.

• Cost and affordability issue remains as the main problem in deploying proprietary Electronic Medical/Health Records Software

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Research Objective

• To develop an Open Standards (flexibility & interoperability) of Web based (ubiquitous) Electronic Health/Medical Records to help the Alarm Call Center Team and Fleet of Emergency Paramedics to easily access patient health information before and during medical emergency cases.– Open Standards mean not only the application is built from an open

source based programs and it is free (does not mean free of cost), but also the application will allow to create a dynamic space for users to write their own description/preference that can be kept locally or shared with other users.

• To evaluate the efficiency and cost benefits (lowest cost possible) of Open Standards EMR/EHR to support the Emergency Medical Service Operation compared to the existing Solution of the manual Emergency Medical Service Operation

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Pre-Hospital Emergency Service OperationAlarm Call Center, Fleet Paramedics and Urgent Care Point Facility

Urgent Care PointFacility

Dispatcher

Pre arrival Instruction to paramedics using

Analog Radio Communication

Wireless Internet AccessTo Receive

Patient Health Info

Telecommunicator

internet

SMO

Web Hosting

Fleet of Paramedics

Open StandardsEMR/EHR

Patient Call Alarm Call Center

Figure 3. EMS Information SystemSource: Self Designed

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Patient’s Management in Medical Emergency Situation

Telecommunicator must able to recognize signs and

symptoms of Emergency situation

(Medical or Trauma)

Telecommunicator inform Dispatcher of :

Patient’s locationContact numberChief Complaints

Name of the callerLevel of Consciousness

Breathing statusCall status

Name of the patientPatient’s AgePatient’s Sex

Patient’s Allergy Past Medical / Trauma History

Additional :Last meal

Last activity

Confirm HOT CALLPress Alert

Tone

1 2

3

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Figure.4 Patient’s managementSource: Emergency Medical Service Standards Requirements

For Emergency Patient Medical Data

Research Methodology

• How to build an Open standards EMR/EHR ?– OpenEHR Archetype Editor (Max Clinical Sets of Data that is

Globally shared)– OpenEHR Knowledge Manager (Search Engine of Globally

shared Archetypes Data Available)– Extracting Basic Archetype Data from ADL/XML format into Java

Environment (JDK and JRE).– Constructing Web based Java Environment EMR/EHR

Application from Open EHR Archetypes Data structures by using Eclipse Software.

– Creating mysql Database for storing medical/health data format.– Exporting database into an XML language format for better

options in mobile users/remote pc access (HTML).

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Research Methodology

• Why is OpenEHR ?– It is an open standards medical data structures

and features that provide not only standard interoperability solution, but flexibility as well in constructing data layer in EMR/EHR.

– It contains Maximum Set of Globally Common Clinical Concept as Archetype Data Set.

– Common medical/health parameters and tags are set to global standards.

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Research Methodology

• Why built over Java Environment?– Java can be implemented over independent platform,

which means it is a free platform based language– It is more sophisticated because it is most commonly

used as a community based language; therefore, it is more promising in provides interoperability for long term future.

– Java language provide flexibility and compatibility in different computer & server platforms from Unix, Windows, Linux and etc.

– It is an open source and free language provided by sun micro system corporation.

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Research Methodology

• Why use MySQL database?– MySQL has easy learning curve for database– MySQL provides best compatibility with java

language environment since both now acquired by sun micro system.

– Best interoperability as well for a small database but can provide high performance on any server such as Apache server (mostly used in the world).

– It is free database provided by sun micro system corporation.

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Research Methodology

• Why use XML data format?– Most of mobile browser interface now is using x-html,

c-html, or the original html format; therefore, exporting data into xml format will allow the data to be mapped easily and rule based into a mobile web browser environment by using XSLT as an xml processor

– XML Data format provide faster real time functionality with a more simple codes to use compared to database format.

– XML Data format will also give more possibility to be extracted into different technology.

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Research MethodologyConstruction of Open Standards EHR/EMR Application for

Emergency Medical Services

OpenEHR Archetypes

ECLIPSE (Front End)

Web Browser Template (Input Method)

Text Based View (Output Method)

ADL / XML based Language Data

Java Environment Application Design

(Java Programming)

Web Browser based EMR/EHR

Application

XML Data in File System

(rule based)

Extracted

OpenEHR Data Structures

Java Environment Application Design

&OpenEHR

Data Structures

Mapping

Execute Export/Save

Patient Demographic

&Medical Data(Common &

Special Health)

Save/Edit(MySQL Database

Format)Ocean Informatics Application

Developer Care Point Clinician & Doctor Alarm Call Centre

&Fleet of Paramedics

Patient EMR/EHR Health will be displayed in

HTML browser format interface

Save/Edit

Import

Remote PC/Mobile Environment

Figure 4. OpenEHR ConstructionSource: Self Designed

XSLT(XML processor)

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Research MethodologyOpen Standards EHR Database Application on Java Environment

PC User (web browser)

Dat

a w

ill b

e vi

ewed

in

HTM

L Fo

rmat

File System

XML Data

Open Standard EHR Server Application on Java Environment

OpenEHR Data MySQL Database

Mir

ror

JAVA Servlet

XML

XSLT

JAVA Server Page

<CONTROL>

<VIEW>

<MANAGE>

INTERNETWide Area Network

Fleets of Paramedics

Mobile Client User (web browser)

Alarm Call Center/other

Clinics

Main Clinic for Urgent Care Facility

(MVC)Pr

oduc

e da

ta in

H

TML

Form

atRe

ques

t dat

a in

H

TML

Form

at

Figure 5. Application LayerSource: Self Design from Java MVC Modelling

Web Server App

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Research MethodologySimple Use Case Diagram

Figure 6. Use Case Source: Self Designed

<User Log in>

<User Search Client> <User Input Data>

JAVA Servlet

User IDPassword

DATA

TRANSFORM

TOOL

Java Servlet

XML

XSLT

HTML

Request

DATA

TRANSFORM

TOOL

Java Servlet

XML

XSLT

HTML

Request

Response Response

Transfer to JSP(Extraction)

Transfer to JSP(Extraction)

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Research Target

• Open Standards EHR/EMR Prototype Application (Static) for the Emergency Medical Service Patient.

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Research Conclusion

• Social and Economic Evaluation over Open Standards EMR/EHR Application compared to Proprietary EMR/EHR Application.

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Further Research Study

• Link to Dolphin Server Environment Project.

• (MML Format Conversion).

• Dynamic java based openEHR application with all the 200+ archetypes data structures included within the system.

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